Table 1.

Sequential use of BCR::ABL1-targeted TKIs is the current standard of care for patients with CML-CP (2, 3).

	1L	2L	≥3L	T315I
NCCN	Low-risk score a Preferred regimens: 1G TKI (imatinib); or, 2G TKI (bosutinib, dasatinib, or nilotinib) Intermediate- or high-risk score Preferred regimens: 2G TKI (bosutinib, dasatinib, or nilotinib); Other recommended regimen: 1G TKI (imatinib)	Switch TKI b and evaluate for allo-HCT if BCR::ABL1 IS is >10% at 6 or 12 mo Switch TKI or continue same TKI (other than imatinib) and consider allo-HCT evaluation if BCR::ABL1 IS is >1% to 10% at 12 mo or >10% at 3 mo	Same as for 2L Consider: (bullet) Ponatinib, asciminib, or omacetaxine for patients resistant to or intolerant of ≥2 TKIs	Ponatinib (preferred) Asciminib Omacetaxine Allo-HCT
ELN	Any approved TKI	Switch TKI b and evaluate mutations for treatment failure or resistance Consider: • Patient and physician choice and options for supportive care for intolerance • Patient factors (e.g., age, comorbidities, AEs with 1L TKI) for suboptimal response	Consider: • Sensitivity to specific TKIs after mutational analysis • Allo-HCT in patients with suboptimal response to ≥2 TKIs	Ponatinib

1G, first generation; 1L, first line; 2G, second generation; 2L, second line; 3L, third line; AE, adverse event; allo-HCT, allogeneic hematopoietic cell transplant; CML-CP, chronic myeloid leukemia in chronic phase; ELN, European LeukemiaNet; ELTS, EUTOS long-term survival; IS, International Scale; NCCN, National Comprehensive Cancer Network; TKI, tyrosine kinase inhibitor.

^aBased on Sokal, Euro, or ELTS score.

^bSwitch recommendations based on response to prior TKI as assessed by BCR::ABL1 ^IS level.